Skin Conditions in Sports

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Chapter 17

• Skin Conditions in Sports

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Anatomy of the Skin
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Anatomy of the Skin (cont.)

• The skin is the largest organ of the body.
• Two major layers- dermis and epidermis.
• Skin thickness varies regionally thickest skin
  is on the soles of the feet and palms of the
  hands.

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Anatomy of the Skin (cont.)

• Skins functions
• Protection from environment.
• Maintenance of bodys fluid balance.
• Protection against disease organisms.
• Temperature regulation.
• Housing for sensory nerves.
• Production of vitamin D.

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Anatomy of the Skin (cont.)

• Skin Damage
• Wounds
• Exposure to UV light
• Temperature extremes hot or cold
• Pathogenic organisms bacteria, viruses, fungi,
  parasite
• Allergies

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Other Skin Conditions

• Ultraviolet LightRelated Skin Problems
• Summer/fall sports often expose large areas of
  skin to harmful rays.
• Summer sportswear typically does NOT cover arms
  and legs.
• Even a minor sunburn can be harmful.

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Ultraviolet LightRelated Skin Problems (cont.)

• UVA and UVB are both harmful, UVB seems more
  related to the development of skin problems.
• Individuals with lighter skin, red hair, and
  freckles are at higher risk for skin damage.
• Exposure to sun at any time can result in
  sunburn, but most dangerous times are between
  1000 A.M. and 200 P.M.

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Ultraviolet LightRelated Skin Problems (cont.)

• Sunburn has two clinical phases.
• Immediate erythema phase involves reddening of
  the skin.
• Delayed erythema phase develops within a few
  hours of exposure, peaking at 24 hours.
• Most cases involve mild discomfort.
• Severe forms include blister formation, chills,
  and gastrointestinal distress.

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Prevention and Care of Sunburn

• The primary concern is to protect exposed skin
  when outdoors.
• Apply sunscreen
• Ears, nose, lips, back of the neck, forehead,
  forearms, and hands.
• Sunscreen products should have a sun protection
  factor (SPF) rating of at least 15.

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Prevention and Care of Sunburn (cont.)

• Sunscreen products contain chemicals which absorb
  or reflect UVA or UVB.
• For best results, apply sunscreen in advance of
  exposure and reapply every 60 minutes.
• Treatment of sunburn is symptomatic apply
  topical anesthetic as well as skin lotion to
  relieve burning and dryness.
• In severe cases, medical referral is warranted.

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Skin Infections

• Various organisms cause skin infections
  including fungi, bacteria, viruses, parasites.
• May be symptoms of more serious infections or
  allergic conditions including Lyme disease,
  herpes, or contact dermatitis.

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Tinea

• Tinea (ringworm) fungal infection that often
  affects the groin (tinea cruris), feet (tinea
  pedis), and scalp (tinea capitus).
• S/S- small brownish-red elevated lesions that
  tend to be circular in shape.
• Itching and pain is with tinea pedis and tinea
  cruris.
• Tinea pedis often includes cracking between toes,
  oozing and crusting lesions, and scaly skin.

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Tinea Treatment

• Keep the affected area clean and dry.
• Apply over-the-counter topical treatment.
• Apply a moisture-absorbing powder to the area.
• Wear clothing made of natural fibers such as
  cotton.

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Tinea Versicolor

• Tinea versicolor (TV) is a fungal infection that
  occurs most often during warm weather, and the
  infection typically involves teenagers and young
  adults.
• Signs and symptoms include circular lesions that
  appear lighter or darker than adjacent skin.
• TV lesions usually appear on upper trunk, neck,
  and abdomen.
• Treatment involves prescription drugs with weeks
  or months required for cure.

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Bacterial Skin Infections

• Bacterial infections common in sports with close
  physical contact.
• Collectively called pyoderma (pus
  producing-infections/lesions of the skin).
• Athletes should be removed from participation and
  referred to a physician
• Pyoderma are caused by Staphylococcus aureus and
  Streptococcus infections, which are common in
  sports with close physical contact.

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CA-MRSA

• Community acquired methicillin-resistant
  staphylococcus aureus
• Aka Staph.
• Small pimple like lesion
• Often mistaken for insect bite
• Usually occurs at the site of a previous wound
• Resistant to some antibiotics

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CA-MRSA

• Treatment
• Antibiotics
• Often require hospitalization for IV antibiotics
• Repeated occurrences warrant nasal swab test to
  I.D. potential carriers
• Return to play
• No published guidelines
• Physicians call

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CA-MRSA
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CA-MRSA

• Prevention
• Wash hands thoroughly before and after treating a
  wound
• Shower immediately after activity
• Athletes with open wounds should not be in
  whirlpools or hot tubs
• Do not share towels, razors, athletic clothing,
  or equipment

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CA-MRSA

• Athletic clothes and towels should be properly
  washed after each use
• Facilities and equipment kept clean
• Refer all athletes with active skin lesions that
  do not respond to initial therapy
• Follow proper first aid procedures
• Suspicious lesions should be referred for testing
• All skin lesions covered before sports
  participation

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Furuncles

• Boils
• Infected hair follicle
• Similar to folliculitis but infection is deeper
• Tender, red nodules

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Carbuncles

• Clusters of boils

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Furuncles and Carbuncles

• Treatment
• Warm moist compresses 3 per day, 10 min each
• DO NOT POP
• Clean and dress opened pus pockets
• If it never comes to a head, physician may need
  to open it

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Furuncles and Carbuncles

• Return to play
• Not contagious
• Playing with them can cause further tissue damage
• Can return after 5 days of antibiotics if no new
  lesions occur within 48 hours

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Folliculitis

• Staphylococcus aureus infection in hair follicles
• May occur after shaving or hot tub exposure
• Papules and pustules around hair follicles
• Tx-
• OTC acne meds
• Topical or systemic antibiotics

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Folliculitis

• Athletes may play with active folliculitis

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Impetigo

• Caused by staphylococcus aureus bacteria
• Honey colored, crusted lesions
• Commonly on the face and other exposed areas
• Common in wrestlers, swimmers, and gymnasts

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Impetigo

• Tx.
• Hydrogen peroxide
• 7-10 days of antibiotics
• topical or systemic
• Return to play
• Lesions are dried
• After 5 days of antibiotics
• No new lesions within 48 hours

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Impetigo
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Viral Skin Infections

• Common viral infections among athletes are
  plantar warts, herpes, and molluscum contagiosum.
• The spread of viral skin infections requires
  direct skin contact

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Warts

• Warts are common. Caused by human papillomavirus
  (HPV)
• Infection is contagious.
• S/S- abnormal buildup of epidermis around the
  region of infection

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Warts

• Tx
• Donut pad to dissipate weight bearing forces
• Can be pared down
• OTC wart removal meds (salicylic acid)
• Cryotherapy
• Excision

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Warts
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Plantar Warts

• Caused by HPV-1 and HPV-4
• Found of the soles of the feet
• Can occur within a callus
• Grow into the foot rather than on the surface
• Appear to have little seeds within the core of
  the wart
• Tx- Direct application of chemicals and removal
  by surgery.

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Plantar Warts
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Herpes Simplex Virus (HSV)

• Two types of HSV
• HSV-1
• Herpes labialis
• Herpes gladiatorum
• HSV-2
• Genital herpes
• HSV can go dormant and return later

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Herpes Labialis

• Caused by HSV-1
• S/S
• single vesicle or cluster of vesicles
• Burning
• Tingling

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Herpes Labialis

• Tx
• OTC ointments
• Oral antivirals
• Prevention
• Antivirals can be used to prevent return of
  lesions during season

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Herpes Labialis

• Return to play
• Athletes with direct skin-to-skin contact are not
  allowed to participate with active lesions
• Lesions must be crusted
• No new lesions within 3 days
• At least 5 days of antivirals

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Herpes Labialis
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Herpes Gladiatorum

• Herpes gladiatorum is caused by HSV-1.
• Lesions occur in area of existing open wounds
• Virus may remain dormant for months or years.

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Herpes Gladiatorum

• S/S-
• Blister-like lesion.
• Open draining lesions, then crusted and begin to
  heal.
• General fatigue, body aches, and inflammation of
  lymph glands.
• Occurs most frequently on head, face, and
  extremities
• Medical emergency if it spreads to eyes

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Herpes Gladiatorum

• TX-
• Oral antivirals
• RTP
• Same as Herpes Labialis

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Herpes Gladiatorum
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Molluscum Contagiosum

• Caused by molluscum contagiosum virus
• S/S
• Dome shaped papules with a center dimple
• Can be individual papules or groups of papules

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Moluscum Contagiosum

• Tx
• Removal of lesions
• Laser
• Cryotherapy
• Salicylic acid
• Return to play
• Athletes can return once lesions have been
  removed
• Wound area must be covered with gas-permeable
  dressing

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Allergic Reactions

• Allergies
• Can result from exposure to a wide variety of
  chemical agents.
• Contact dermatitis can result from contact with
  plants, particularly poison ivy, poison sumac,
  and poison oak.

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Contact Dermatitis

• Contact with poison ivy, poison oak, and poison
  sumac results in allergic reactions in 90 of
  adults.
• Offending chemicals are in the sap.
• Average time from exposure to reaction is 24 to
  48 hours.
• Healing requires 1 to 2 weeks.

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Contact Dermatitis

• S/S-
• itching and redness of skin
• Blisters that often break open and become
  crusted.
• Wet, weeping skin

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Contact Dermatitis

• Susceptible athletes should learn to recognize
  poison ivy, poison oak, and poison sumac.
• Avoid areas where these plants grow.
• Outdoor events, such as cross-country running,
  should be staged away from high-risk areas.

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Contact Dermatitis

• Tx-
• Identify the irritant or allergen and eliminate
  exposure
• Topical coritcosteroid ointments
• OTC antihistamines

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Contact Dermatitis
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Allergic Reactions

• Allergies related to chemicals in clothing and
  sports equipment have recently received
  attention.
• Allergies to rubber, latex, topical analgesics,
  resins, and epoxy are common.
• Some people are allergic to synthetic rubber that
  is in sports shoes, swim caps, goggles, and
  earplugs.
• An athlete suspected of having an allergic
  dermatitis should be referred to a dermatologist.

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